Realist theory building for social epidemiology

Abstract

Background and Aims: It is increasingly recognised that major adult public health issues, related to development, behaviour and lifestyle have their origins during pregnancy, infancy and early childhood. The aim of this study is to utilise mixed methodology to build a conceptual framework, theory and model describing the mechanisms by which multilevel factors influence the developmental and life course outcomes with a focus on perinatal depression. Methodology and Methods: I used a critical realist approach to social epidemiology theory building. Emergent methods included: key informant interviews, focus groups, thematic analysis, conceptual mapping, situational analysis, factor analysis, logistic, linear, and Bayesian spatial and multilevel regression studies. Explanatory theory building utilised abductive Inference to the Best Explanation. Results: Theoretical concepts emerging included: loss of expectation, marginalisation, loss of control, nurturing and support, social support networks, access to services, ethnic migration and the role of global economy, business and media. Multilevel spatial studies suggest that strong ecological social networks increase depression among migrant mothers but not Australian mothers. Discussion The study found accumulating evidence that maternal stress, during and after pregnancy, is a cause of maternal depression and altered developmental trajectory of her infant. Emerging was the centrality of expectation lost as a possible trigger of stress and depression. Global, economic, social and cultural mechanisms were identified that explain maternal stress and depression within family and neighbourhood contexts. The challenge for policy and practice is to support mothers and their partners during the transition to parenthood. The Thesis In the neighbourhood spatial context, in keeping with critical realist ontology, globaleconomic, social and cultural level generative powers trigger and condition maternal psychological and biological level stress mechanisms resulting in the phenomenon of maternal depression and alteration of the infants’ developmental trajectory.